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Symposium on Emergency Cardiovascular Care
Round Table II:
Moderator: Pascual De Pietro, MD
Departamento de Emergencias I.C. y C.C., Fundación Favaloro, Buenos Aires, Argentina
From their origins the man had demonstrated an unbroken concern to reverse the death. From the mythical intent of Isis restoring the life to Osiris, or the well-known biblical description of Eliseo returning to the life to the son of the Sunamita, overcoming myths and beliefs, conquering social and religious barriers, the search of the mechanisms that reverse the death continues being one of its main objectives.
From the beginnings of the years 60, with the contributions of Safar, Elam, Kouwenhoven and other, form was given to the concept of Cerebral and Cardiopulmonary Resuscitation as we know it in our days. The Chain of Survival, applied precociously, is constituted, this way, in a fundamental tool in the prognosis of the victims of sudden death. The application of this sequence is characterized by a community vision of the problem with the participation of diverse actors: pedestrians, family, transportable systems of emergency, technicians, medical, paramedics, firemen, policemen, emergency departments and other areas of critical care and internment, etc.
On the other hand, our knowledge on the underlying mechanisms of the sudden death, the widespread hipoperfusión with the consequent hypoxia and ischemia, the sequence of the metabolic changes and of the internal medium, they have allowed us to have an approach to the understanding of the cascade of events that take to the cellular death and the factors that modulate this method, like they are, among other, the longevity of the ischemia, the reperfusión presence, the effects neurohumorals, the oxygen pressure, the accumulation of metabolic products of refuse and the specific susceptibility of each organ to the insult. To understand the mechanisms that take to the cellular death and the factors that modulate this method, is critical for the evolution of methods that limit the cellular dysfunction post arrest and death.
The administration of drugs that collaborate with the reestablishment of an appropriate rhythm of perfusion, as well as of their maintenance, it constitutes a main part of the Advance Cardiac Vital Support. Inside them the use of Agonistas Adrenergics has demonstrated to be main, mainly in instances where the desfibrilación has failed and where the tone vasomotor acquires fundamental importance. From the works of Szymonowicz, Cybulski, Oliver and Schafer at the end of the XIX century and the recommendation of their use for the American Heart Association (AHA), since today Adrenaline is, maybe, the drug more studied in this context. Endogenous catecholamines with a agonist effect, generates increase of the pressure of coronary and cerebral perfusion thanks to a mechanism of redistribution of flux for increase of the systemic vascular submitted. For their effect to ago to the most susceptible Ventricular Fibrillation to the defibrillation, on the other hand, their controversial ß effect, the myocardic work increases generating a bigger oxygen consumption. However it is still to wonder if it is all this envelope the use of the Adrenaline in the cardiac arrest.
The behavior observed by the Vasopresine proposes a new option in the handling of patient in this context, mainly as vasoconstrictor not outlying adrenergic through receiving V1 and potentializing the effect of the endogenous catecholamines. Although the results are controverted, a new expectation opens up with regard to the therapeutical arsenal in the handling of the cardiac arrest.
I delight, because, in introducing to the Physicians Osvaldo Rois, Alfredo Sierra, Mark Henry and Eric Niegelberg. All professionals of comprehensive scientific trajectory that will develop in this table different thematic associated with the pharmacological handling and modifications of the internal medium generated during the cardiac arrest. Their opinions, undoubtedly, will contribute clarity to these concepts giving impulse to our daily stress of saving lives.
Alfredo Sierra Unzueta
2nd Virtual Congress of Cardiology
Dr. Florencio Garófalo
Dr. Raúl Bretal
Dr. Armando Pacher
Technical Committee - CETIFAC
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